Massachusetts Medical Society: Testimony in Opposition to Legislation to Increase the Scope of Practice for Optometrists

Testimony in Opposition to Legislation to Increase the Scope of Practice for Optometrists

The Massachusetts Medical Society wishes to be recorded in opposition to the following bills that would expand the scope of practice for optometrists by allowing them to treat glaucoma and to prescribe oral therapeutic medications:

  • H.1906, “An Act Ensuring Consumer Choice and Equal Access to Eye Care” (Haddad)
  • H.1923, “An Act Modernizing Optometric Patient Care” (Jones)
  • H.1924, “An Act Relative to the Treatment of Glaucoma” (Jones)
  • S.1239, “An Act Ensuring Consumer Choice and Equal Access to Eye Care” (DiDomenico)
  • S.1308, “An Act ensuring consumer choice and equal access to eye care” (Moore)

The MMS also opposes H.1925, “An Act Studying the Impacts of the Diagnosis Restrictions on Optometrists” (Jones).  This bill would require the Department of Public Health, the Department of Professional Licensure and the Board of Registration in Optometry to produce a report on costs imposed on Massachusetts residents from the current statutes that restrict optometrists from treating glaucoma. Upon completion of the report, the bill would direct the DPH and Board of Registration in Optometry to hold a public hearing and would then authorize the Commissioner of Public Health to promulgate regulations to broaden the scope of practice for optometrists.

Doctors of optometry are not medical doctors. Below are the statutory requirements for licensure of optometrists (M.G.L.Chapter 112,  Section 68):

“that he has graduated from a high school having a course of study of four years and approved by the board or has had a preliminary education equivalent to at least four years in public high school, and that he has graduated from a school or college of optometry, approved by the board, maintaining a course of study of not less than two years with a minimum requirement of fifteen hundred attendance hours or in the case of a person applying for a first examination after January first, nineteen hundred and thirty-five, maintaining a course of study of not less than three separate academic years, each academic year consisting of thirty-six weeks of classroom work with thirty hours of instruction each week and this course of study shall include ninety-five hours of study in the following areas:”

Compare the licensure requirements for optometrists and ophthalmologists.  Physicians have four year undergraduate degrees, attend medical school for four years and complete at least a one year internship.  Physicians who become ophthalmologists usually have a three year residency which follows this internship and may have further years of subspecialty training.  Ophthalmologists have between 12-16,000 total patient care hours required through training, plus internship. 

The difference in the length of study is important but the subject matter is the real key.  Optometrists study the physical structure of the eye.  They learn how to recognize deformities and how to change the way light reaches the eyes as a means of compensating for such deformities and defects.  They are taught to recognize that certain deformities and defects may indicate the possible presence of disease. However, the statutory educational requirements for licensing are worth a careful review.  The statute specifies the following requirements, among others: eight hours in pharmacology, three of which shall be in pediatric pharmacology; and ten hours in indications and ocular effects of commonly prescribed drugs, two of which shall be in indications of effects in pediatric situations;…two hours in pediatric eye diseases; two hours in glaucoma; and one hour in ocular emergency.

The entire emphasis of optometry training is to ensure that vision deficiencies are corrected through the use of corrective lenses.  Optometrists change lenses, not the tissue of the eyes.  Optometry is a different profession from the treatment of disease.  The prospect of optometrists treating disease through oral medications or performing any form of surgery on the eye or the face is not warranted based on the educational requirements for licensing listed above.

For these reasons the MMS urges an “Ought Not to Pass” recommendation for H.1906, H.1923, H.1924, S.1239, S1308, and H.1925. 

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